颌骨肿物为始发症状的肾透明细胞癌:2例报告及文献复习

肾透明细胞癌(renal clear cell carcinoma, RCC)早期即发生远处转移,但极少转移至头颈部。本文基于2016—2018年间联勤保障部队第940医院2例以颌骨肿物为始发症的RCC病例,回顾RCC的发病特点及临床表现,分析颌骨病变的临床、影像学及病理特点,为减少误诊误治提供参考。     

On the differential diagnosis of clear cell tumours of the head and neck

Clear cell tumours, both benign and malignant, derive from a diverse group of epithelial cell types including renal epithelium, keratinising epithelium, cutaneous adnexa, salivary glands, odontogenic epithelium, melanocytes and even mesenchymally derived cells of adipose and tendon sheath. In the head and neck, clear cell tumours represent a singular challenge to the pathologist since the classic morphological features of malignant neoplasia exemplified by cytological atypia are frequently absent in malignant clear cell variants, thereby excluding reliance on this histopathological hallmark for the establishment of a diagnosis. The differential diagnosis of both benign and malignant clear cell tumours must take into account patterns of growth as well as the phenotype of accompanying cell populations when attempting to arrive at a definitive histological diagnosis. In this review article, the histopathology of head and neck tumours that harbour significant clear cell populations will be compared and contrasted.     

A SEER analysis of survival and prognostic factors in merkel cell carcinoma of the head and neck region

While Merkel cell carcinoma (MCC) of the head and neck is highly malignant, it remains poorly characterized due to its rarity. The purpose of this study was to examine prognostic factors for overall survival (OS) and disease-specific survival (DSS) in patients with MCC of the head and neck region. The Surveillance, Epidemiology and End Results registry was reviewed for patients diagnosed between 1984 and 2016 with histologically confirmed, primary MCC of the head and neck region. A total of 2818 patients met the inclusion criteria, with a median age at diagnosis of 77 years. At five and 10 years, respectively, the OS was 42.4% and 25.1% and the DSS was 67.9% and 64.1%. Multivariate Cox analysis indicated that predictors of decreased DSS included age at diagnosis ≥75 years, white race, increasing tumor spread, lymph node involvement and either the lip or the scalp/neck as a primary site. When adjusting for the aforementioned factors, tumor depth was not found to be a prognostic factor for DSS. We anticipate these results will help clinicians to counsel patients regarding expectations and potential prognosis.     

Carcinoma ex pleomorphic adenoma of the submandibular gland: report of a case with an unusual malignant component of clear cell squamous cell carcinoma

A large carcinoma ex pleomorphic adenoma (CXPA) with regional lymph node metastasis occurred in the left submandibular gland of a 64-year-old man. Initially, the patient underwent tumor extirpation and ipsilateral radical neck dissection. Histologic examination revealed the malignant component of CXPA was clear cell squamous cell carcinoma (SCC), which is quite uncommon in head and neck region. In the metastatic regional lymph nodes, aggregates of clear cells were observed. To the best of our knowledge, this is the first case of CXPA of which the malignant component is clear cell SCC. Four months after the postoperative radiotherapy, delayed regional metastasis became evident in the contralateral side of the neck. Radical neck dissection was carried out, and, microscopically, moderately differentiated SCC was identified. The patient recovered well and remained free of disease for 29 months after the second surgery.     

Metastatic renal cell carcinoma from a primary tumor removed 14 years previously

It is not uncommon for renal carcinomas to present with a solitary metastasis. However, this patient was initially seen with multiple metastatic lesions. The five-year survival rate in such cases is very low, i.e., less that 5%.⁶ It is unfortunate that the initial diagnosis of Wilm's tumor was in error, as postoperative radiation therapy might have been of some value in ablation of residual tumor foci. It is, however, doubtful that radiation therapy and/or chemotherapy would have altered the eventual outcome of this disease. Although the diagnosis of a clear cell metastatic tumor to the head and neck is difficult because of the multiplicity of clear cell malignancies that can occur in this area, a primary tumor of the kidney must always remain high in the differential diagnosis.     

Genetic profile of clear cell odontogenic carcinoma

In the head and neck region, clear cell tumors are usually derived from salivary glands, odontogenic tissues, and metastasis. The World Health Organization has classified clear cell odontogenic tumor among benign tumors, but it is now recognized as a more sinister lesion, and current opinion is that it should be designated as a carcinoma. It is characterized by aggressive growth, recurrences, and metastasis. By using complementary DNA microarrays, several genes in clear cell odontogenic tumor were identified that are differentially regulated when compared with non-tumor tissue. In conclusion, the first genetic profiling of clear odontogenic carcinoma is reported. DNA microarrays can potentially help in identifying some genes whose products could be disease-specific targets for cancer therapy as well as a tool for better classifying odontogenic tumor.     

Perineural spread of squamous cell carcinoma of the lip: the importance of follow-up and collaboration

Perineural spread (PNS) of mucosal squamous cell carcinoma of the head and neck region occurs with a reported frequency of 2% to more than 27%. Patients previously diagnosed with and treated for head and neck cancer should be closely followed by both their physician and their dentist in order to facilitate the coordination of care. This case history demonstrates the results that can occur when a team approach to head and neck cancer is not followed, especially in a patient who is an infrequent and somewhat reluctant health care utilizer. Despite mandibular pain, the patient, who had a history of a carcinoma of the lower lip and had developed PNS, was not referred to a dentist. In patients with a previous history of squamous cell carcinoma, sensory and/or motor changes must be closely monitored when there is a suspicion of PNS. The outcome of this case supports improved collaborations between physicians and dentists in following head and neck cancer patients.     

Metastatic renal cell carcinoma to the condyle of the mandible

A 59-year-old woman who had left nephrectomy because of renal cell carcinoma (RCC) 3 years ago referred with trismus and a mass on her left temporomandibular joint. Computed tomography scan revealed an expanding lytic lesion on the left condyle of the mandible. Incisional biopsy was carried out. Histopathologic diagnosis was metastatic clear cell variant of RCC. Metastasis of RCC to the condyle of the mandible has not been reported yet. In this study, we presented a case of RCC metastasis to the condyle of the mandible.     

口腔颌面-头颈部眶外巨细胞血管纤维瘤的临床及病理特征分析

目的: 探讨口腔颌面-头颈部眶外巨细胞血管纤维瘤（extra-orbital giant cell angiofibroma,EO-GCA）的临床病理特征、鉴别诊断及治疗方法。方法: 收集整理Pubmed数据库中已报道的12例口腔颌面-头颈部EO-GCA文献资料,并结合我院2例患者的临床病理资料进行分析。结果: 14例患者（男9例,女5例）年龄24~84岁,平均43.5岁。肿瘤多数生长缓慢,大小与发生部位有关。镜下见肿瘤细胞呈卵圆形或短梭形,以富含血管和多核巨细胞为特征。免疫组织化学CD34及vimentin等间叶组织标志物呈阳性。临床极易误诊,确诊依赖于术后病理学检查,手术完整切除后复发少见。结论: 口腔颌面-头颈部EO-GCA是一种罕见的软组织良性肿瘤,临床易误诊,确诊依赖于组织病理学检查,手术完整切除后预后较好。     

Merkel cell carcinoma of the tongue and head and neck oral mucosal sites

Merkel cell carcinoma (MCC) is an uncommon primarily dermal malignancy of relatively aggressive biologic course. Several presentations in the mucosa of the head and neck region have been reported in the literature, and 3 such patients have recently been seen at our institution. We review this recent experience and present the first reported primary lingual MCC in a 57-year-old caucasian man. We provide a review of oral mucosal MCC and guidelines for histopathologic and immunohistochemical diagnosis. Merkel cell carcinoma should be included in the differential diagnosis of head and neck mucosal lesions, especially if the tumor is submucosal, and MCC may involve the tongue. Mucosal MCC is aggressive, and there is a high risk for local recurrence and regional and distant metastasis. Fulminating courses are often seen. We discuss our treatment policies based on the current literature.     

MRI对双侧头颈部软组织病变的诊断意义

目的:基于双侧头颈部软组织病变的临床不典型性,旨在探讨核磁共振(magnetic resonance imaging,MRI)对其进行鉴别诊断的影像学依据。方法:对本组32例发生于双侧头颈部的软组织病变进行MRI检查,并与病理学结果进行对照。结果:本组32例的MRI诊断与病理学诊断结果的符合率约为84%(27/32)。结论:MRI是对累及双侧头颈部软组织病变的重要检查手段,并能为明确其诊断提供影像学依据。     

磁共振导航下细针穿吸诊断头颈深部肿块的应用价值

目的:评价磁共振导航下细针穿吸诊断头颈深部肿块的应用价值。方法:对12例头颈深部肿块患者行磁共振导航定位引导下细针穿吸细胞学检查,男9例,女3例,年龄15-63岁。肿块位于颞下窝6例,腮腺深叶3例,翼下颌间隙2例,咽旁间隙1例。结果:所有12例肿块经磁共振导航下穿吸针均显示达到肿块中心;穿吸细胞学检查6例与术后病理符合,1例不符:另5例穿吸细胞学为炎症,未进行手术探查,现随访正常。穿吸诊断准确率为91.67％,敏感度为80％,特异度为100％;穿吸过程中无明显并发症。结论:磁共振导航下细针穿吸细胞学检查是一种定位准确、诊断准确率高且安全的检查方法,尤其适应于头颈部深部肿块的诊断。     

A man from Africa with a swelling in the head and neck region

A general dental practitioner can, in the daily practice, be confronted with a patient with a swelling in the head and neck region. For such swellings an extensive differential diagnosis exists. Often such a swelling is caused by one or more enlarged lymph nodes due to a bacterial or viral infection. If a swelling in the head and neck region has been present for some time--longer than 4 weeks--then there is a considerable chance, especially in adults, that it is the result of the metastasizing of a malignancy, such as a squamous cell carcinoma in the oral mucosa or another mucosal site in the head and neck region. In addition to lymph node swellings resulting from a malignancy, diseases are now more frequently encountered which were previously uncommon in the Netherlands, due in part to the growing number of people with a non-Western ethnic background. Tuberculosis is such a rare disease, which can in the first instance express itself in the form of a lymph node swelling in the head and neck region.     

Intramuscular vascular malformation of the masseter muscle presenting with turkey wattle sign

Intramuscular vascular malformations are unusual tumors in the head and neck region. Less than 1% of vasoformative tumors throughout the body occur in skeletal muscle; 15% of them arise in head and neck musculature. Masseter muscle is the most frequent site for such vascular malformations; it accounts for approximately 5% of all intramuscular vascular malformations in the head and neck region. A case of unusual intramuscular vascular malformation of masseter muscle is described and the diagnosis and management of these tumors is discussed.     

Autopsy findings in patients with head and neck squamous cell cancer and their therapeutic relevance

A series of 63 autopsied patients with a history of head and neck squamous cell cancer (HNSCC) is reported with emphasis on the importance of locoregional disease (LRD) versus distant metastasis (DM) in the terminal course of the disease. There were 49 males and 14 females; mean age 64.9 years (range 35–94 years). Locoregional disease was present in 39 patients (62%), in 25 (40%) without tumour at other body sites outside the head and neck region. Distant metastasis was observed in 15 patients (24%); in 12 (19%), it occurred with concomitant LRD. Second primary tumours (SPT) were observed in 20 patients (32%). They occurred in the head and neck region (n = 7; 11%), the lung (n = 9; 14%) and at miscellaneous other sites (n = 4; 6%). Of the 13 patients with SPT outside the head and neck region, 2 had concomitant LRD. 11 patients (17%) died due to other causes, no tumour being found at autopsy. These figures indicate that still a major part of HNSCC patients die with LRD as the single tumour manifestation, which means that improvement of local tumour control will result in a significant therapeutic gain.     

咽旁软组织透明细胞肉瘤1例

软组织透明细胞肉瘤多发生于四肢末端,尤其是足和踝最为常见,躯干和头颈部偶可发生。本文报告1例发生于咽旁的软组织透明细胞肉瘤。     

多学科协作诊疗模式在口腔鳞癌中的实践进展

口腔鳞状细胞癌是头颈部最常见的恶性肿瘤之一.虽然口腔鳞癌的诊疗水平取得了一定进步,但患者总体生存率并无显著改善,需要前瞻性临床研究推动诊治水平的进一步提升,优化和更新诊治指南.多学科协作诊疗模式(multidisciplinary team,MDT)在口腔鳞癌疑难病例的治疗中已经显示出其优越性,得到了广泛认可.为了进一...     

Large cell neuroendocrine carcinoma of the floor of mouth and retromolar trigone in association with basaloid squamous cell carcinoma

Large cell neuroendocrine carcinoma and basaloid squamous cell carcinoma are each rare but aggressive diseases of the head and neck. A case of large cell neuroendocrine carcinoma occurring simultaneously with a basaloid squamous cell carcinoma originating from the oral cavity is described in this report. The diagnosis of these pathologies can be challenging but is important, as staging and treatment recommendations differ from those for oral cavity squamous cell carcinoma.     

Primary Giant Cell Rich Osteosarcoma of Maxilla: An Unusual Case Report

Giant cell rich osteosarcomas, histological variant of conventional osteosarcomas account for 3% of all cases of osteosarcomas and most of them are arise from the appendicular skeleton. Giant cell rich osteosarcomas have been rarely reported in the head and neck region. This is the first case report of giant cell rich variant of osteosarcoma in the maxilla. It is important to recognize this variant, as its prognosis is worse as compared to conventional osteosarcomas of the head and neck region. We here present a case of giant cell rich variant of osteosarcoma of the maxilla and along with its characteristic radiological and histopathological picture.     

Renal cell carcinoma: A rare metastasis to the tongue--a case report

This paper describes the diagnosis and treatment of a patient who presented with a lesion on the left posterior scalp, who was also experiencing more generalized signs of malaise. Biopsy led to the diagnosis of renal cell carcinoma and additional lesions developed in the tongue. About 1% of all malignancies found in the oral cavity are metastatic. CLINICAL RELEVANCE: Metastases to the head and neck are uncommon but should always be considered among the differential diagnoses of lesions.